Marlborough RFC The Common, Frees Avenue, Marlborough, Wiltshire, SN8 1DL 01672 514717 www.marlboroughrugbyclub.co.uk

Marlborough RFC Membership Form – 2008/09

Name:

Address:

Postcode:

Telephone:

Mobile:

e-mail:

School (Juniors only):

Please detail any relevant medical information that the club should be aware of, e.g. Asthmas, Allergies, etc.

Emergency contact number:

Please tick
Playing Member	£45.00*
50% for Students / serving members of the Armed Forces / Unemployed
Junior Member (Under 7 – Under 17)	£35.00*
Social Member	£5.00
Vice President (suggested minimum contribution)	£45.00
* £5 discount if paid by 30^th September 2008
New members joining after 1^st January 2009 charged at 50%

Cheques to be made payable to: Marlborough RFC

The club sometimes take photographs or vide footage for publicity purposes. These images may appear in our printed publications or on the club’s website and may also be sent to the news media. However, before taking and pictures, we need your permission.

Please circle
I give my consent for this:	Yes / No

Signed (Player / Parent / Guardian):

For further information please contact:

Bob Lillywhite, Membership Secretary

Tel: 01672 511164, e-mail: louis.lillywhite@yahoo.co.uk

Note: All new players must also complete an RFU form and include four passport size photographs